Healthcare Provider Details

I. General information

NPI: 1679887244
Provider Name (Legal Business Name): THE SALVATION ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 1ST AVE NE
ROCHESTER MN
55906-3700
US

IV. Provider business mailing address

20 1ST AVE NE
ROCHESTER MN
55906-3706
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-5191
  • Fax:
Mailing address:
  • Phone: 507-288-5191
  • Fax: 507-281-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number802185-2-ADC
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: ALLISON UTHKE-SCALETTA
Title or Position: GOVERNMENT GRANTWRITER
Credential: DELEGATED OFFICIAL
Phone: 651-746-3543